Simulated haemodynamic parameters and different infusion set-up affect drug delivery during syringe pump change over: A bench-top study in a laboratory setting.

Autor: Lucchini A; Direction of Health and Social Professions - Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; General Adult and Pediatric Intensive Care Unit Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy. Electronic address: alberto.lucchini@unimib.it., Elli S; Direction of Health and Social Professions - Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; Vascular Access Team, Fondazione IRCCS San Gerardo dei Tintori - Monza, Italy. Electronic address: stefano.elli@unimib.it., Burgazzi A; Neurosurgey - Spedali Civili Di Brescia, Brescia, Italy. Electronic address: a.burgazzi@campus.unimib.it., Malvestuto Grilli L; General Adult and Pediatric Intensive Care Unit Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy. Electronic address: laura.malvestutogrilli@irccs-sangerardo.it., Pes C; Emergency Department, Asst Bergamo Ovest, Treviglio, Italy. Electronic address: c.pes1@campus.unimib.it., Ferrari K; General Adult and Pediatric Intensive Care Unit Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy. Electronic address: katia.ferrari@irccs-sangerardo.it., Fumagalli L; General Adult and Pediatric Intensive Care Unit Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy. Electronic address: letizia.fumagalli@irccs-sangerardo.it., Fiorillo C; General Intensive Care Unit, Azienda Ospedaliera Policlinico di Modena, Italy. Electronic address: fiorillo.chiara@aou.mo.it., Giani M; General Adult and Pediatric Intensive Care Unit Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy. Electronic address: marco.giani@unimib.it., Rezoagli E; University of Milano-Bicocca and Department of Emergency and Intensive Care Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy. Electronic address: emanuele.rezoagli@unimib.it.
Jazyk: angličtina
Zdroj: Intensive & critical care nursing [Intensive Crit Care Nurs] 2024 Oct 16; Vol. 86, pp. 103861. Date of Electronic Publication: 2024 Oct 16.
DOI: 10.1016/j.iccn.2024.103861
Abstrakt: Background: Infusion therapy is widely used in clinical settings, particularly in intensive care units.
Aim: to explore the influence of simulated cardiac output on "bolus" or "backflow" events that can occur during syringe pump changeover, considering several factors that have been previously outlined in published research. Syringe infusion pumps are commonly used for precise continuous intravenous drug delivery. Syringe pump changeover can be a challenging procedure.
Methods: Bench-top study in a laboratory setting. An extracorporeal circuit was used to simulate a cardiac output of 5 l/min. The following variables were used: three levels of vertical position of the syringe pump (-50 cm, 0, +50 cm), three levels of Central Venous Pressure (-5, 10, and 15 mmHg), presence/absence of carrier infusion (5 ml/h), and presence/absence of a needle-free connector between the syringe and extension line.
Results: A total of 108 syringe pump changes were performed with different combinations of the investigated variables. The mean time for syringe pump changeover was equal to 9.48 ± 2.45 s and the overall fluid displacement was 8 ± 40 µL (microlitres) (range, -262-156 µL). The CVP level and vertical position of the pump always statistically affected the overall displacement during syringe pump changeover. When a second infusion with an equal velocity rate to that of a syringe pump infusion is present in the same lumen, the presence of a needle-free device reduces the overall volume of displacement.
Conclusions: Syringe pump changeover can be a critical moment for patients when vasoactive drugs are administered.
Implications for Clinical Practice: In a simulated environment with a cardiac output of 5 L/min, the CVP level and vertical position of the syringe pump generated bolus or backflow events during the syringe pump changeover. The application of carrier infusion appeared to intensify these phenomena. Employing a neutral, needle-free system can potentially aid in reducing the development of boluses or backflows.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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